BACKGROUND: Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening situations. OBJECTIVE: To review cases of peripartum hysterectomy in respect of indications, risk factors and complications. DESIGN: A retrospective study. SETTING: King Edward VIII Hospital, Durban. SUBJECTS: Seventy one cases of Caesarean and post-partum hysterectomy performed between January 1993 and June 1998. RESULTS: The rate of peripartum hysterectomy was 1:836 deliveries. Fifty eight per cent of the hysterectomies followed Caesarean section. The main indications for hysterectomy were ruptured uteri, uncontrollable haemorrhage from atonic uteri, sepsis and morbidly adherent placenta. Perinatal mortality was high and there were four maternal deaths. CONCLUSION: Peripartum hysterectomy is a necessary life-saving operation. Prevention of complications that give rise to emergency hysterectomy should decrease maternal and fetal morbidity and mortality.